The prevalence of papilliary thyroid microcarcinomas is very high. A great majority has an excellent prognosis. However some of them lead to local recurrences or distant metastasis. Therefore it should be important do detect high risk factors to choose between conservative or aggressive treatment. However this proves to be difficult and it seems reasonable to perform in most instances a total or near total thyroidectomy with nodal disection. TSH suppression treatment is routinely advocated but not adjunctive radioiodine ablation. This approach authorizes an easier long term follow up.